Histology--Heme & Lymphoid Neoplasms: How is histology coded for a pathologic diagnosis of "B-cell lymphoma, unclassifiable, with features intermediate between DLBCL and Burkitt lymphoma" that was clinically referred to as a "double hit lymphoma"?
Code histology to 9680/3 [diffuse large B-cell lymphoma (DLBCL)]. Per the Alternate Names section in the Heme DB, B-cell lymphoma, unclassifiable, with features intermediate between diffuse large B-cell lymphoma and Burkitt lymphoma is one of the synonyms for for DLBCL.
SEER*Educate provides training on how to use the Heme Manual and DB. If you are unsure how to arrive at the answer in this SINQ question, refer to SEER*Educate to practice coding hematopoietic and lymphoid neoplasms. Review the step-by-step instructions provided for each case scenario to learn how to use the application and manual to arrive at the answer provided. https://educate.fhcrc.org/LandingPage.aspx.
MP/H Rules/Multiple primaries--Breast: Does rule M10 apply in this situation?
L breast biopsy = INVASIVE DUCTAL CARCINOMA
L breast simple mastectomy = 2.0 cm INVASIVE DUCTAL CARCINOMA with an incidental finding of separate 1.0 cm INVASIVE LOBULAR CARCINOMA; pathologist specifically states the tumors are morphologically different. The tumors are both pure Ductal/pure Lobular.
Yes, Breast rule M10 applies. This case is a single primary.
Follow the MP/H rules even though the "pathologist specifically states the tumors are morphologically different" so that situations like this are reported consistenty accross cancer registries, regions, and states for consistent national reporting.
Histology--Heme & Lymphoid Neoplasms: How is this field coded when the final diagnosis for excisional biopsy of two cervical lymph nodes shows classical Hodgkin lymphoma, histologic subtype cannot be determined, but the COMMENT section of the report indicates there are features of both lymphocyte rich and nodular sclerosis subtypes?
Per Rule PH28, code histology to 9650/3 [Classical Hodgkin lymphoma]. This rule states to code the non-specific (NOS) histology when the diagnosis is one non-specific (NOS) histology and two or more specific histologies.
SEER*Educate provides training on how to use the Heme Manual and DB. If you are unsure how to arrive at the answer in this SINQ question, refer to SEER*Educate to practice coding hematopoietic and lymphoid neoplasms. Review the step-by-step instructions provided for each case scenario to learn how to use the application and manual to arrive at the answer provided. http://seer.cancer.gov/seertools/hemelymph.
Ambiguous Terminology/Reportability: How should the expressions "suspicious for but not diagnostic of" and "suspicious for the possibility of early invasive adenocarcinoma" be interpreted for reportability? Would the interpretation be different depending on the primary site?
For reportability, interpret "suspicious for but not diagnostic of" as NOT diagnostic of cancer.
The phrase "suspicious for the possibility of early invasive adenocarcinoma" may indicate that the case is in situ. If no further information is available, this is not reportable.
The site of the cancer diagnosis does not change the interpretation.
MP/H Rules--Breast: What histology code is used for lobular with focal ductal features? Do we ignore the focal features and code as lobular or do we use the combination code for duct and lobular?
For cases diagnosed 2007 or later, use rule H14 and assign code 8520 [lobular]. Ignore histologies described as "focal," "foci," or "focus." This instruction will be added to the next version of the MP/H manual.
Primary site--Heme & Lymphoid Neoplasms: How is the primary site coded, and which PH rule applies, when chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) is diagnosed simultaneously by biopsies of both lymph node(s) and the bone marrow?
Code the primary site to C421 [bone marrow] per Rule PH5 when CLL/SLL [9823/3] involves the bone marrow.
In the later stages of CLL/SLL, there may be involvement of bone marrow AND lymph node(s), lymph node region(s), organ(s), or tissue(s). As long as the peripheral blood and/or bone marrow are involved, the primary site is bone marrow.
WHO states that the diagnostic criteria for CLL versus SLL is not clearly defined. According to WHO guidelines, it is better to code to CLL/SLL and code the primary site to bone marrow when the marrow is involved and to lymph nodes, organ, or tissue when there is no bone marrow involvement.
SEER*Educate provides training on how to use the Heme Manual and DB. If you are unsure how to arrive at the answer in this SINQ question, refer to SEER*Educate to practice coding hematopoietic and lymphoid neoplasms. Review the step-by-step instructions provided for each case scenario to learn how to use the application and manual to arrive at the answer provided. https://educate.fhcrc.org/LandingPage.aspx.
Radiation Therapy--Breast: If hospital records indicate that a mammocyte intracavitary radiation therapy device was placed in the breast, but there is no follow-up documentation of radiation actually being given, should we code radiation 2 (implants) or 8 (recommended, unknown if given)?
Assign code 8 [recommended, unknown if administered]. Check this case periodically, and others coded 8. Update if further information becomes available.
EOD-Extension--Corpus Uteri: How is this field coded for a stage III A endometrial primary with positive pelvic washings, involvement of the omental serosa, and negative lymph nodes?
For cases diagnosed 1998-2003: Code EOD-extension as 85 [Metastasis]. According to our TNM consultant, Omental metastasis is M1, Stage IVB [EOD 85].
Reportability--Hematopoietic, NOS: Is a "myeloproliferative disorder" reportable when the pathology report comment states this likely represents the "early/cellular phase of myelofibrosis/myeloid metaplasia" with cytogenetics and PCR pending?
For cases diagnosed prior to 1/1/2010:This case is not yet reportable. The bone marrow diagnosis "myeloproliferative disorder" is not reportable to SEER. It is likely that if this condition progresses, it will eventually be reportable.
For cases diagnosed 2010 forward, refer to the Hematopoietic and Lymphoid Neoplasm Case Reportability and Coding Manual and the Hematopoietic Database (Hematopoietic DB) provided by SEER on its website to research your question. If those resources do not adequately address your issue, submit a new question to SINQ.
CS Tumor Size--Lung: If a 5/11/07 CT showed a 6.5 cm LLL mass and a 7/24/07 CT showed 8.4 cm LLL mass, do we code the larger tumor size identified within four months of diagnosis or do we code the first size documented at the time of diagnosis?
This answer was provided in the context of CSv1 coding guidelines. The response may not be used after your registry database has been converted to CSv2.Code the larger tumor size.
An official website of the United States government
Home